Hepatitis Treatment

Hepatitis Treatment

1. Hepatitis B

   • Pegylated alpha interferon
     • Expensive, contraindications, side effects
     • No resistance
     • 48 wks subcutaneous
     • eAg+ : low response, high sustained response
     • eAg- : high response (60%), low sustained response
     • Flu-like, cytopaenia, depression
   • Oral anti-virals: suppress viral replication
     • Examples
       • Lamivudine: no longer used due to low durability of response
       • Adefovir: poor response durability @5yrs
       • Entecavir
       • Tenofovir
     • Effectiveness: high response to treatment, low retained response
     • Side effects: few
     • 1/day indefinitely

2. Hepatitis C

   • Pegylated alpha interferon + Ribavirin
     • Duration
       • Genotypes 1&4: 48 weeks, 45% success
       • Genotypes 2&3: 24 weeks, 80% success
     • Side effects
       • Pegylated interferon: fatigue, malaise, neutropaenia, thrombocytopaenia, depression, insomnia, weight loss, alopecia
       • Ribavirin: pruritis, anaemia, rash, nasal congestion
     • Contraindications
       • Interferon: severe depression, psychosis, cardiac failure, autoimmune disease, pregnancy
       • Ribavirin: renal failure, pregnancy
   • HCV N23/4A inhibitors
     • Boceprevir
       • Anaemia, dysuguesia
       • 68% sustained response
     • Telaprevir
       • Severe rash, anaemia, nausea
       • 75% sustained response
     • Clinical use
       • Genotype 1 only
       • Triple Therapy with IFN/Ribavirin: reduced tolerance due to combined side effects